Wow. You work in Paeds? I thought it was only adult medicine (and occasionally adult general surgery) where they screw with the staffing numbers so badly. I like this line that I saw today: Registered Nurse staffing levels: It's not a matter of TLC, it's a matter of life and death". People have this silly "angel" image of nursing....the hand holding and stuff. They don't realise that poor RN staffing is actually extremely deadly. They think that as long as they have a "smart" doctor and a "nice" nurse that they are in good shape. Wrong. I have been a nurse for over a decade and believe me. I care more about my nurse being smart and a quick thinker who can analyse a whole lot of information very quickly. If she is nice and caring as well then that is a bonus.

Hang on it is going to get worse.

Nightowl I am afraid to say that these people do not understand the situation and are not going to make waves. Hospitals are now hell bent on getting as many patients in and out with as few qualified staff as possible, and it is going to get worse I'm afraid. They are bringing in ideas that utterly destroyed nursing care in america in the 1990's. I can't believe that they think shorter shifts are the answer. Their lack of understanding regarding nurse patient ratios and what nurses do is the problem here. I am still trying to figure out how to get threw to them. But I always hope that I am wrong. I have my fingers crossed for you. Most hospitals really come down on nurses who speak out and refuse assignments so I am glad to hear that they are listening. As always, keep us updated.

I hope it gets better! Please keep us updated.

Or maybe the doc made a spelling error or something or didn't like the way he prescribed it so he just crossed it off and grabbed a new chart. Different charts for different areas as well.

The drug chart has each drug prescribed on it with the time to be given. There are 31 horizontal boxes next to each drug because their are 31 one days in each month. On the 1st of the month I show that I gave the drug at the correct time by putting my initials in the first box. On the second day of the month I put my initials in the second box, to the right of the first. And so on and so forth. When we get to the last day of the month we are probably on the far right of the chart and there are probably no more boxes to put my initials in. Therefore I cannot give the drug until the chart is re -written because I cannot sign for them properly. When that happens, the junior doc will put a big giant x over last months chart and write "rewritten" on it. Then he rewrites the drugs onto a new chart and the old one gets filed. It is a very antiquated system of doing things.

A lot of good reviews here. Amazon.com: Nursing Against The Odds: How Health Care Cost Cutting, Media Stereotypes, And Medical Hubris Undermine Nurses And Patient Care (The Culture and Politics of Health Care Work) (9780801439766): Suzanne Gordon: Books The centre of nursing advocacy can have a one track mind with their reviews. They rub me the wrong way at times. I worked in the US for awhile and the UK for a long time as well. The similiaries are striking. The hospitals have behaved in the exact same manner. But the conditions here in the UK are triple brutal for nurses. The public here has a much more backward, ignorant view of nurses and what a nurse is and that is probably why. The same management consultants who destroyed care on hospital wards USA were hired by the NHS I think. This is kicked off early to mid 1990-ish and is reaching a head now.

Night Owl, The NHS is currently using world war two era models of staffing and they are doing in with lower proportions of qualified staff on the wards than you had in previous decades. When you take into account that patients are becoming sicker, more complicated, the elderly population is exploding and that we are now expected to do more with less in order to cut costs it is no wonder that standards of care are declining. The hospitals are also full of patients who would be better suited for a nursing home but there are not enough care homes to care for them all. They languish in hospital instead. But the ward they are on is only staffed with enough RN's to stay on top of things like crisis management and IV drugs. The set up does not allow us to actually "care for" medically stable elderly patients who merely need help with activities of daily living. There are no elderly wards at my hospital. Elderly patients with dementia who need one to one care in order to avoid falls and accidents are being placed on wards where their nurse already is up to her eyeballs with multiple acutely ill patients. Of course it is not bad everywhere yet. The general medical wards seem to be the ginger haired step children of the NHS. Some of our surgical and ortho wards are functioning okay. I am really getting sick of all of the "fallen angels" and "too posh to wash" rubbish. It's as if people think that if only the nurse was a little more compassionate or a little less educated that she would suddenly have the ability to answer 10 call bells, feed 25 people, manage critically ill and deteriorating patients as well as answer a non stop ringing phone all at once whilst holding hands and being patient and sympathetic. It's a joke. Of course media stereotypes and journalists in general don't help things. The picture they portray of nursing is so way off the mark it is scary. The public's view of nursing and what nurses should be doing comes from the subconscious images that they developed after years of watching Casualty, ER, and House. I actually had one person ask me why we were so stressed with life and death responsibility. She thought that we have ward doctors around to manage all aspects of care and that the nurse merely assists him. This is how people think. There is one good journo. Her name is Suzanne Gordon and she wrote a book about nursing called Nursing Against the Odds. Her basic idea is that media stereotypes cause the public to have messed up and dysfunctional views of nurses and that is why they become abusive towards nurses. They have unrealistic expectations that don't get met and then they get angry. That hospital cost cutting, poor working environments and changes in health care dynamics are leading us to a nurse-less society. She has concluded that the reason things have become so bad and unrealistic for nurses is because of that whole angel image. All these things cause registered nurses to flee the bedside which is what cost cutting hospitals want. It is a book I highly recommend for anyone who wants to know why nursing care in hospital is so bad.

"How self-obsessed are you? How about fireman, ambulance crew, police, teachers?" In the US registered nurses have higher salaries than all of the above listed by you. I lived there for years. I have known many fireman, teachers, cops, and ambulance crew who have gone into nursing and every single one will tell you that hospital nursing is 10x harder, with higher levels of responsibility and critical thinking skills needed. Every one of them. The UK has almost no chance of hanging onto any of her nurses. In parts of the US and Canada now, they have strictly legislated RN to patient ratios. This means that no RN can take more than 5 patients at a time, and if one of her patients becomes so critically ill that she cannot leave his bedside she gets another RN to care for her other 4 patients. UK nurses do not have any of this. If one of her nurses goes downhill, there is no one to care for her other 12 or 15. This is law over there and in Oz and it is being implemented and it is more cost effective to hire RN's than it is to cause patient deaths and complications from lack of RN's. They will be poaching all your nurses. And ff you are going to lay into a nurse caring for 20 acutely ill patients for not filling in water jugs you pretty much deserve to lose them all. Another piece of advice-never assume that all the staff you see hanging about the nurses station are nurses. And never assume that they are personel that can assist your or know about your loved ones condition. They probably are not and the real nurse who is responsible will be up to her eyeballs and trying to avoid any interruptions just to up her chances of getting critical drugs out on time and critical assessments made.

Since 1990 there has been something like a 110% increase in patient acuity (that means they are sicker and more complex) and a 30% reduction (intentional by management) of registered nurses at the bedside. And it gets worse every year. So I really have no patience from the input of nurses who worked years ago and left the wards pre-1990's. If you don't understand that registered nurse is not always going to be able to fill a jug or fetch a blanket (something we are not happy about, we want to do these things)then you don't really even have a fundamental understanding of what a registered nurse is or what they have on their shoulders. In 1996 I worked on a lovely short stay surgical where I never had more than 6 patients and I always had a charge nurse to back me up in a critical situation. I was able to do everything for my patients and we never had any complaints or abuse. In general medicine the wards are not set up that well, as a matter of fact their nurses are set up to fail. These are the wards where our elderly patients (my mum and dad) get admitted when their heart failure kicks off, or they are septic or have pneumonia. Their nurse doesn't stand a chance and neither do they. These wards and the staffing matrixes have to be restructured.

Sali, Nightowl's methods have been tried by thousands of nurses up and down the country for years. THey have all failed and things are getting worse. I hope she succeeds and hope that she lets us know. Since 1990 hospital managers in the globally have dealt with spiralling costs, sicker patients requiring more complex care by slashing the numbers of Registered Nurses on the wards and replacing them with untrained assistants. This is why nursing care is so bad. The nurses are overwhelmed. You are sharing your nurse with so many other people that she cannot even keep them straight and dealing with the top priority stuff is like being on a hamster wheel. Just getting life saving meds and equipment that are prescribed out of the blue takes lots of form filling and hoop jumping. The situation now, is a heck of a lot worse than it was in say 1995. Nurses never received the abuse etc that they receive now. It is horrific. Take it from someone who is currently working in a high level short staffed acute area of a struggling trust. I understand your comments about the water jugs and the blankets but I think you miss the point. Unless you know exactly what is happening with your nurse's other patients at that moment in time, unless you understand the hoops she has to jump through to sort it all out, unless you understand the consequences of her making the wrong decision about where to be and when then you do not understand why she hasn't brought that water jug or blanket. I am devoted to basic care and comforts for my patients but during the course of a 14 hour shift I find it impossible, impossible to even get a minute uninterrupted to check on the basics. It is hellish and I am not kidding. It was not this bad even 5 years ago. I take offense at the implication that Nurses do not understand what it is like to be on the otherside. I elderly parents that are in and out of hospitals, days without their leg ulcer dressings being changed. I have a husband with a chronic illness that causes him to be in and out of hospital. I have a son with special needs. I have been a hospital patient on wards similiar to my own. We do get the other side. We get both sides. You do not. I understand that if my nurse has another patient that is critical than she cannot even leave him for two seconds to fetch a water jug. I understand that she is forced to take more of these patients than she can handle due to intentional understaffing by hospital chiefs. I get that if she makes the wrong decision about where to be and when then she could end up before a judge very easily. In the states I saw a nurse jailed for missing some critical lab values getting phoned in, resulting in a death. The reason she missed them was because she was playing handmaiden servant to the relatives of another patient who thought that she should be there at all times, the minute their dad rang his bell for a blanket etc. This is true. This happens. You have to be willing to understand that on a general ward your nurse has more patients than she can handle or get to in a shift, that she is constantly interrupted to a point that she cannot even give a drink without getting interrupted between pouring the water into the glass and getting that glass to the patient's lips. It is this bad in many places. IF this is how it is, and hospital chiefs are hellbent on not staffing and running the wards properly then you need to get used to the idea that you cannot expect your nurse to appear immediately and work on your schedule. I am sick of the public expecting one to one care and then refusing to acknowledge the situation the wards. This is a terrible state of affairs. If I am ever sick again I want my nurse there immediately. Under the current conditions on the wards she will not be there for hours even for something simple like helping me with a snack. This is why I blog about it and people are indeed listening. The situation was similiar in the US for years and nothing changed until the nurses really stepped things up and became militant and outspoken.

Sali as a nurse I often jump right on stuff like that...asking a doc if he wants to review a patients drug chart because certain things are prescribed together etc etc. It usually takes about 3 days to sort out, so overwhelmed with jobs are the docs and nurses. As a trained nurse I have so many patients that it is completely impossible to keep on top of everything that is happening with them. I will make a mental note of anything a relative tells me and add it to the list of jobs depending on where it is on the priority scale (because they know the patient better) but I ain't stopping for more than two seconds to talk about it since I can barely get to my patients at all during the time allowed. But aspirin can be given on occasion with warfarin, depends on the INR. When the INR changed maybe they decided to stop it. Zippy makes good points about HCA's not knowing what they do not know. I used to be an HCA and I never understood why the nurses did the things that they did, when they did, whilst not tending to other things that *I* thought were the most important right away. I understand now.

Night Owl, I completely sympathise. You did the right thing. I have been blogging on a site called Militant Medical Nurse about these same issues. I work on a 25 bed medical unit that takes everything from care of the elderly, acute medicine, ortho, surgical, psychiatric, and HDU when no beds are available. We are lucky if we have 2 RN's per shift. The minimum safe levels of patients to RN is 1:6, and that is only if acuity is low and the RN has good back up. There is no excuse for this. Management could have these wards staffed if they wanted to. They don't want to and they know and laugh over the fact that the public gets it's jollies over slamming "cruel nurses". In 13 years of nursing I have yet to meet a cruel nurse or a nurse that is too posh to wash. It is cost effective to have more RN's on duty because of the decrease in sentinal events that occur with safe RN ratios. But the public just blames the nurses so management gets away with intentional short staffing. Not too long ago I had 3 patients who were pre arrest and a few more critical ones. I was the only RN on duty. I was at the desk trying to get a doc and infusion pumps ordered so I could implement orders for these patients and I was bombarded with visitors laying into me because I wouldn't drop what I was doing and bring someone a pillow. Sometimes I think visitors who behave like this want us to kill critical patients or something. A couple of patients nearly died because I couldn't get past visitors screaming about patients not getting helped with their meals. Did they not think that I would have helped those patients if I didn't have other critical ones? Do they really think that one RN can feed 12 people by herself in 20 minutes? They are all nuts. Not one of them ever complains to management about the nurse patient ratios. When the nurses complain, we get ignored. When a patient gets harmed the nurse gets the blame which includes striking off the register and possible criminal charges. Management walks free and just rants on about teaching the nurses about dignity to improve things. What a joke. Hospital administration is like the general public. They don't know what a nurse is....and they don't want to pay any to be around. They think that a 17 year old who gets a job in the hospital caring for patients is a "nurse". It's sick. Anyway I would love for you to do a guest post on my blog. It is all anonymous of course. The NMC just shoots the messengers.